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D-penicillamine and immune complex deposition.

J D Kirby, P A Dieppe, E C Huskisson

    Annals of the Rheumatic Diseases
    |August 1, 1979
    PubMed
    Summary

    D-penicillamine treatment for rheumatoid arthritis can cause toxic reactions, including lupus-like syndromes, due to immunoglobulin deposits. These deposits and decreased immune complex levels suggest immune system involvement in adverse drug reactions.

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    Area of Science:

    • Immunology
    • Rheumatology
    • Dermatology

    Background:

    • D-penicillamine is used to treat rheumatoid arthritis.
    • Toxic reactions and lupus-like syndromes have been reported with D-penicillamine therapy.
    • The underlying mechanisms of these adverse effects are not fully understood.

    Purpose of the Study:

    • To investigate the presence of immunoglobulin deposits in patients experiencing toxic reactions to D-penicillamine.
    • To correlate skin biopsy findings with clinical presentation and laboratory markers.
    • To explore the role of immune complexes in D-penicillamine-induced side effects.

    Main Methods:

    • Skin biopsies were performed on patients undergoing D-penicillamine therapy.
    • Immunofluorescence microscopy was used to detect immunoglobulin deposits at the epidermo-dermal junction.
    • Serum immunoglobulin and complement levels were measured before and during treatment.

    Main Results:

    • Dense, granular immunoglobulin deposits were found at the epidermo-dermal junction in 40% (4/10) of patients with toxic reactions.
    • Similar deposits were observed in 3 out of 4 patients who developed a lupus-like syndrome.
    • Significant decreases in serum immunoglobulin and complement levels were noted during D-penicillamine treatment.

    Conclusions:

    • Widespread deposition of immune complexes may contribute to various side effects of D-penicillamine, beyond just nephropathy.
    • Immunoglobulin deposits in the skin are associated with toxic reactions and lupus-like syndromes in patients treated with D-penicillamine.
    • These findings highlight the immunomodulatory effects of D-penicillamine and its potential to trigger autoimmune phenomena.

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